Management of Corneal Ulcers : A Systematic Review of Treatment Options
Abstract
Introduction: Corneal ulcers represent a significant cause of ocular morbidity and potential vision loss worldwide. The management landscape is diverse, encompassing antimicrobial therapy, anti-inflammatory agents, surgical interventions, and novel adjunctive treatments. A systematic synthesis of high-quality evidence is crucial to inform optimal, evidence-based clinical strategies.
Methods: A systematic review was conducted following a pre-defined protocol. Eighty studies, including randomized controlled trials (RCTs), systematic reviews, and meta-analyses, were included after screening based on strict criteria focusing on human studies of corneal ulcers reporting clinical outcomes. Data extraction covered study design, ulcer characteristics, interventions, healing, visual, and safety outcomes.
Results: For bacterial keratitis, fluoroquinolone monotherapy (e.g., moxifloxacin) demonstrated equivalent efficacy to fortified antibiotic combinations but with a better ocular tolerability profile (McDonald et al., 2014; Sharma et al., 2013). Adjunctive corticosteroids showed no overall benefit in the SCUT trial but provided significant visual improvement in severe, centrally-located, non-Nocardia ulcers when initiated early (≤3 days) (Srinivasan et al., 2012; Ray et al., 2014). For fungal keratitis, natamycin was superior to voriconazole for filamentary fungi, particularly Fusarium (Sharma et al., 2015; Qiu et al., 2015). Surgical adjuncts like amniotic membrane transplantation…
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